Provider Demographics
NPI:1609054089
Name:COLORADO CENTER FOR BONE RESEARCH, P.C.
Entity Type:Organization
Organization Name:COLORADO CENTER FOR BONE RESEARCH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-980-9985
Mailing Address - Street 1:3190 S WADSWORTH BLVD
Mailing Address - Street 2:250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4899
Mailing Address - Country:US
Mailing Address - Phone:303-980-9985
Mailing Address - Fax:303-980-1367
Practice Address - Street 1:3190 S WADSWORTH BLVD
Practice Address - Street 2:250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4899
Practice Address - Country:US
Practice Address - Phone:303-980-9985
Practice Address - Fax:303-980-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18842207RN0300X
CO46158207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016341Medicaid
COD23508Medicare UPIN
COC434508Medicare PIN